Invisalign® Smile Assessment

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Take the Smile Assessment now to find out if Invisalign is right for you or someone in your family. While not a substitute for a consultation with an Invisalign Provider, it will provide a detailed, personalized assessment.

Are you:

Date of birth of person that would enter treatment:

MM

DD

YYYY

Your primary goal for treatment is:

How do you feel about the spacing of your teeth?

Tell us about your dental history - do you have or have you had any of the following?

I still have baby teeth

I had braces

I had teeth pulled (e.g., wisdom teeth)

I currently have missing teeth/gaps

I currently have false teeth

I currently have a bridge, fillings and/or crowns

I currently have braces

I hadcosmetic work done (veneers, implants, etc.)

Acute periodontal disease

None of the above

When it comes to straightening your teeth, which of the following is most important to you?

Do you have orthodontic insurance and/or access to Flexible Spending Account (FSA)?

Do you participate in any of the following activities?

Student Government

Sports/Athletics

Socializing with friends/dating

Music/Band

Drama/Theater

Debate/Public Speaking

How much research have you done?

How much research have you done

If Invisalign Teen is the right choice for me, I intend to start treatment:

If Invisalign is the right choice for me, I intend to start treatment:

Discover the Secret
to Your Beautiful Smile.

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The patient and any other person responsible for payment has a right to refuse to pay, cancel payment or be reimbursed for payment for any other service, examination or treatment that is performed as a result of and within 72 hours of responding to the advertisement for the free, discounted fee or reduced fee service, examination or treatment.*Conditions Apply*